LAKE HAVASU CITY

SWIMMING POOL COVERREBATE APPLICATION

The 2016/17 swimming pool cover rebate program is limited to one pool cover per house (or property). Sorry,no liquid cover products are covered under this rebate. The rebate rate is 50% up to $50 of the pre-tax purchaseprice. Pool covers must be purchased between August 1st, 2016 and May 31st, 2017, unless funds areexhausted before the end date. Multiple home (or property) owners are limited to a maximum of 3 poolcovers (one per property). Customers are eligible for a rebate on a first-come, first-served basis, after asuccessful installation inspection, while funds are available. Pool covers must be cut to fit the pool and mustcover 90%-100% of the pool – OR solar mat covers must be purchased to cover 90-100%. The rebate is goodonly for homes within the Lake Havasu City water service area whose water accounts are in good standing.

Please fill out a separate application for each Lake Havasu City water account. Rebates will be issued as a credit on your water bill. Water accounts in good standing will be credited the rebate within 28 business days after apost-installation inspection has confirmed the new pool cover is in good working order. Delinquent wateraccounts are not eligible for rebates. Water accounts must be in good standing before the City can issue arebate.

1) Please print and fill out the rebate application.

2) Purchase and install the swimming pool cover.

3) Attach an original pool cover purchase receipt to this application and take both to the Building Inspection counter at City Hall. The receipt will be copied and returned to you. City staff will call to schedule a post-installationinspection of the pool cover.

Customer Name______

(Person who is to receive rebate) Last Name First Name Middle Initial

Service Address______

(Where pump will be installed) Street, City, State, and Zip Code

Mailing Address______

(If different from above)Street, City, State, and Zip Code

Telephone Number______

Home Work

Receipt Purchase Date ______

Store Where Purchased______

Lake Havasu City Water Account Number ______

Property Owner______

Signature Date

Inspection Verified By:______Date:______

□ Approved□ Disapproved

Water Account Verification By:______Date:______

□ Approved□ Disapproved

Water Account Rebated By:______Date:______

Amount: ______Verified By: ______

Lake Havasu City Pool Cover Rebate ApplicationAugust 1, 2016